Dai Akine,Teppei Sasahara,Yuka Hirota,Hirotomo Kato
Leishmaniasis is caused by an obligate intracellular protozoa of the genus Leishmania. Its clinical manifestations include cutaneous, mucocutaneous, and visceral forms. Sporotrichoid cutaneous leishmaniasis (SCL) is an atypical and rare form of cutaneous leishmaniasis (CL) reported mainly in the Old World. This case report describes SCL in a Japanese man infected with Leishmania (Viannia) peruviana in Peru. His lesions occurred on both feet, with the left foot lesion being a simple CL that resolved spontaneously. However, the lesion on the right foot did not cure by itself; instead, it progressed centrally along the lymph nodes, eventually forming an SCL. Amastigotes were detected in both feet and genetically identified as L. (V.) peruviana. The lesions gradually resolved after treatment with intravenous liposomal amphotericin B. Here, we report the first case of SCL caused by L. (V.) peruviana.
利什曼病是由利什曼属的一种细胞内原生动物引起的。其临床表现包括皮肤型、粘膜型和内脏型。孢子丝状皮肤利什曼病（SCL）是一种非典型、罕见的皮肤利什曼病（CL），主要在旧大陆报告。本病例报告描述了一名日本男子在秘鲁感染秘鲁利什曼病（Viannia）后出现的皮肤利什曼病。他的病变发生在双脚，左脚的病变为单纯的 CL，可自行消退。然而，右脚的病变并没有自行痊愈，而是沿着淋巴结向中心发展，最终形成了 SCL。双脚都检测到了母细胞，经基因鉴定为 L. (V.) peruviana。经静脉注射脂质体两性霉素 B 治疗后，病变逐渐消退。在此，我们报告了首例由 L. (V.) peruviana 引起的 SCL 病例。
{"title":"Case Report: A Case of Sporotrichoid Cutaneous Leishmaniasis Caused by Leishmania (Viannia) peruviana.","authors":"Dai Akine,Teppei Sasahara,Yuka Hirota,Hirotomo Kato","doi":"10.4269/ajtmh.24-0275","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0275","url":null,"abstract":"Leishmaniasis is caused by an obligate intracellular protozoa of the genus Leishmania. Its clinical manifestations include cutaneous, mucocutaneous, and visceral forms. Sporotrichoid cutaneous leishmaniasis (SCL) is an atypical and rare form of cutaneous leishmaniasis (CL) reported mainly in the Old World. This case report describes SCL in a Japanese man infected with Leishmania (Viannia) peruviana in Peru. His lesions occurred on both feet, with the left foot lesion being a simple CL that resolved spontaneously. However, the lesion on the right foot did not cure by itself; instead, it progressed centrally along the lymph nodes, eventually forming an SCL. Amastigotes were detected in both feet and genetically identified as L. (V.) peruviana. The lesions gradually resolved after treatment with intravenous liposomal amphotericin B. Here, we report the first case of SCL caused by L. (V.) peruviana.","PeriodicalId":520106,"journal":{"name":"The American Journal of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
During the COVID-19 pandemic, the use of alcohol-based hand rubs (ABHRs) was critical for improving hand hygiene (HH) among healthcare workers (HCWs). Before and during the pandemic, we supported district-led production and district-wide distribution of ABHRs and one-time provision of portable handwashing stations to select healthcare facilities (HCFs) in five rural districts in Uganda. Comparison between baseline and follow-up assessments showed an overall increase in access to HH materials and HH adherence (HHA; handwashing with soap and water or use of ABHR) among HCWs. However, large differences in the changes in HH material coverage and HHA across districts may have been heavily influenced by the COVID-19 disease burden and its risk perception when the assessments were conducted. Using data collected at multiple time points before and during the pandemic across districts and estimating and controlling for pandemic effects in an exploratory multivariate analysis, the adjusted odds ratio of HHA in district HCFs was 4.6 (95% CI: 1.8-11.8) after (versus before) the ABHR intervention. This increase appeared to be primarily in larger HCFs, where the perceived need for ABHRs may have been greater. Additional strategies are needed to further increase HHA, especially in the smallest HCFs, among laboratory technicians and nurses and before patient contact. However, district-scale ABHR interventions seemed successful in ensuring the continued availability of HH materials.
{"title":"Changes in Access to Alcohol-Based Hand Rub and Hand Hygiene Adherence among Healthcare Workers after a Hand Rub Production and Distribution Program in Rural Uganda before and during the COVID-19 Pandemic.","authors":"Kanako Ishida,Matthew Lozier,Alexandra M Medley,Victoria Trinies,Christiana Hug,Carrie Ripkey,Maureen Kesande,Fred Tusabe,Sauda Yapswale,Francis Ocitti,Herbert Isabirye,Judith Nanyondo,Martin Watsisi,Mohammed Lamorde,David Berendes","doi":"10.4269/ajtmh.24-0040","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0040","url":null,"abstract":"During the COVID-19 pandemic, the use of alcohol-based hand rubs (ABHRs) was critical for improving hand hygiene (HH) among healthcare workers (HCWs). Before and during the pandemic, we supported district-led production and district-wide distribution of ABHRs and one-time provision of portable handwashing stations to select healthcare facilities (HCFs) in five rural districts in Uganda. Comparison between baseline and follow-up assessments showed an overall increase in access to HH materials and HH adherence (HHA; handwashing with soap and water or use of ABHR) among HCWs. However, large differences in the changes in HH material coverage and HHA across districts may have been heavily influenced by the COVID-19 disease burden and its risk perception when the assessments were conducted. Using data collected at multiple time points before and during the pandemic across districts and estimating and controlling for pandemic effects in an exploratory multivariate analysis, the adjusted odds ratio of HHA in district HCFs was 4.6 (95% CI: 1.8-11.8) after (versus before) the ABHR intervention. This increase appeared to be primarily in larger HCFs, where the perceived need for ABHRs may have been greater. Additional strategies are needed to further increase HHA, especially in the smallest HCFs, among laboratory technicians and nurses and before patient contact. However, district-scale ABHR interventions seemed successful in ensuring the continued availability of HH materials.","PeriodicalId":520106,"journal":{"name":"The American Journal of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospital-acquired infections, including surgical site infections (SSIs), pose a concerning challenge because of the growing resistance to multiple drugs, largely influenced by extensive prophylactic antimicrobial therapy. Although SSIs are well documented in advanced hospitals in developed nations, their prevalence and bacterial profiles are inadequately reported in low- and middle-income nations such as Nepal. This retrospective cohort study explored the prevalence of orthopaedic SSIs in relation to bacterial etiology and antimicrobial resistance. We examined the surgical and bacteriological records of patients suffering SSIs (clean or clean-contaminated wounds) within a month of their surgical procedures between January 2020 and June 2022 at the National Trauma Center, Kathmandu, Nepal. The prevalence of orthopaedic SSIs among hospital-visiting patients was 31.2% (448/1,438; 95% CI: 28.8-33.5). There were 341 (76.1%) males and 361 (80.6%) adults with SSIs. Knee/joint infections (n = 141, 31.5%) were predominant. An SSI typically occurs 7 days after surgery. Enterobacterales were dominated by Escherichia coli (n = 54, 40.9%), whereas nonfermenters gram-positive cocci (GPC) were dominated by Pseudomonas aeruginosa (n = 69, 81.2%) and Staphylococcus aureus (n = 216, 93.5%), respectively. Enterobacterales, nonfermenters, and GPC exhibited penicillin resistance at 74.5%, 29.8%, and 65.1%, respectively, whereas cephalosporin resistance was exhibited at 48.3%, 57.1%, and 49.6%; fluoroquinolone resistance at 25.9%, 40.5%, and 25.7%; and aminoglycoside resistance at 21.5%, 43.2%, and 17.3%. One-third of orthopaedic surgeries resulted in SSIs, mainly caused by S. aureus. Fluoroquinolones and aminoglycosides were moderately effective in treating bacterial SSIs, whereas penicillins and cephalosporins were the least effective. Nonfermenters exhibited higher antimicrobial resistance compared with Enterobacterales and GPC.
{"title":"Antimicrobial Resistance in Bacterial Species Causing Orthopaedic Surgical Site Infections at a National Trauma Center, Kathmandu, Nepal.","authors":"Ajaya Basnet,Pramod Joshi,Sailendra Kumar Duwal Shrestha,Laxmi Kant Khanal,Mahesh Karmacharya,Shila Shrestha,Shiba Kumar Rai","doi":"10.4269/ajtmh.24-0038","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0038","url":null,"abstract":"Hospital-acquired infections, including surgical site infections (SSIs), pose a concerning challenge because of the growing resistance to multiple drugs, largely influenced by extensive prophylactic antimicrobial therapy. Although SSIs are well documented in advanced hospitals in developed nations, their prevalence and bacterial profiles are inadequately reported in low- and middle-income nations such as Nepal. This retrospective cohort study explored the prevalence of orthopaedic SSIs in relation to bacterial etiology and antimicrobial resistance. We examined the surgical and bacteriological records of patients suffering SSIs (clean or clean-contaminated wounds) within a month of their surgical procedures between January 2020 and June 2022 at the National Trauma Center, Kathmandu, Nepal. The prevalence of orthopaedic SSIs among hospital-visiting patients was 31.2% (448/1,438; 95% CI: 28.8-33.5). There were 341 (76.1%) males and 361 (80.6%) adults with SSIs. Knee/joint infections (n = 141, 31.5%) were predominant. An SSI typically occurs 7 days after surgery. Enterobacterales were dominated by Escherichia coli (n = 54, 40.9%), whereas nonfermenters gram-positive cocci (GPC) were dominated by Pseudomonas aeruginosa (n = 69, 81.2%) and Staphylococcus aureus (n = 216, 93.5%), respectively. Enterobacterales, nonfermenters, and GPC exhibited penicillin resistance at 74.5%, 29.8%, and 65.1%, respectively, whereas cephalosporin resistance was exhibited at 48.3%, 57.1%, and 49.6%; fluoroquinolone resistance at 25.9%, 40.5%, and 25.7%; and aminoglycoside resistance at 21.5%, 43.2%, and 17.3%. One-third of orthopaedic surgeries resulted in SSIs, mainly caused by S. aureus. Fluoroquinolones and aminoglycosides were moderately effective in treating bacterial SSIs, whereas penicillins and cephalosporins were the least effective. Nonfermenters exhibited higher antimicrobial resistance compared with Enterobacterales and GPC.","PeriodicalId":520106,"journal":{"name":"The American Journal of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scabies is endemic in many resource-poor tropical areas, causing significant morbidity. However, our understanding of the true burden of scabies in Africa is limited, partly owing to limited capacity and challenges accessing the currently recommended diagnostic tools. The primary objective of this study was to assess the diagnostic accuracy of scabies assessments made by minimally trained field-workers. We trained field-workers with a minimum of secondary school education in the diagnosis of scabies. After the training, we assessed the diagnostic accuracy of assessments made by nine field-workers compared with the reference standard. In all, 193 individuals were assessed for scabies. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated, as well as agreement (κ coefficients) between medical doctors and between field-workers. Of the 193 participants, 26% had scabies according to the reference standard. The sensitivity of field-worker diagnosis compared with the reference standard was 94% (95% CI: 90-99%), and the specificity was 96% (95% CI: 90-97%). The determination of severity by field-workers was less accurate; the sensitivity for severe scabies was 61% (95% CI: 48-74%), and the mean specificity was 97% (95% CI: 93-100%). This study demonstrated that field-workers without medical qualifications were capable of diagnosing scabies to a similar level of accuracy as experienced medical doctors after a short period of focal training. This may facilitate rapid assessments of scabies prevalence for public health purposes and decisions about mass drug administration implementation in similar settings.
{"title":"Training of Field-Workers for Rapid Assessment of Scabies Prevalence: A Diagnostic Accuracy Study in Mozambique.","authors":"Joanna Furnival-Adams,Valeria López,Hansel Mundaca,Amelia Houana,Antonio Macucha,Eldo Elobolobo,Aida Xerinda,Humberto Munguambe,Felisbela Materula,Regina Rabinovich,Francisco Saute,Daniel Engelman,Carlos Chaccour","doi":"10.4269/ajtmh.24-0204","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0204","url":null,"abstract":"Scabies is endemic in many resource-poor tropical areas, causing significant morbidity. However, our understanding of the true burden of scabies in Africa is limited, partly owing to limited capacity and challenges accessing the currently recommended diagnostic tools. The primary objective of this study was to assess the diagnostic accuracy of scabies assessments made by minimally trained field-workers. We trained field-workers with a minimum of secondary school education in the diagnosis of scabies. After the training, we assessed the diagnostic accuracy of assessments made by nine field-workers compared with the reference standard. In all, 193 individuals were assessed for scabies. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated, as well as agreement (κ coefficients) between medical doctors and between field-workers. Of the 193 participants, 26% had scabies according to the reference standard. The sensitivity of field-worker diagnosis compared with the reference standard was 94% (95% CI: 90-99%), and the specificity was 96% (95% CI: 90-97%). The determination of severity by field-workers was less accurate; the sensitivity for severe scabies was 61% (95% CI: 48-74%), and the mean specificity was 97% (95% CI: 93-100%). This study demonstrated that field-workers without medical qualifications were capable of diagnosing scabies to a similar level of accuracy as experienced medical doctors after a short period of focal training. This may facilitate rapid assessments of scabies prevalence for public health purposes and decisions about mass drug administration implementation in similar settings.","PeriodicalId":520106,"journal":{"name":"The American Journal of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tuberculosis treatment is sometimes associated with clinical deterioration, referred to as paradoxical reaction (PR), especially in those with HIV coinfection. However, the burden and characteristics of PR in children without HIV coinfection are unclear. We undertook a systematic review to estimate the burden and clinical characteristics of PR in HIV-negative children. We searched PubMed, Embase, Web of Science, CINAHL, Scopus, Cochrane Library, ProQuest, and OpenGrey for studies reporting PR in HIV-negative children (<18 years old). We included observational studies including case series with at least five cases. Data on incidence/prevalence, clinical features, risk factors, management strategies, and outcome of PR were extracted. Risk of bias in the included studies was assessed using the NIH's quality assessment and Joanna Briggs Institute critical appraisal tools. We pooled the prevalence data using random effects meta-analysis. We identified 1,673 studies, of which 10 were eligible for inclusion. They described PR in 133 HIV-negative children. The pooled prevalence was 8.8% (95% CI: 2.9%, 14.6%). Owing to heterogeneity among studies, risk factors for the development of PR could not be identified. Limited data suggested that children developing PR were younger and had neurological or lymph node tuberculosis more often. Most children were treated with corticosteroids, but data were insufficient to identify the optimal management strategy. The review showed that PR affects nearly 1 in 12 HIV-negative children receiving tuberculosis treatment. The paucity of studies emphasizes the need for surveillance/studies to better characterize clinical features, risk factors, appropriate management strategies, and outcome.
结核病治疗有时会导致临床症状恶化，即所谓的 "矛盾反应"（PR），尤其是在合并感染艾滋病毒的患者中。然而，对于未合并感染艾滋病病毒的儿童，PR 的负担和特征尚不清楚。我们进行了一项系统性综述，以估计 HIV 阴性儿童中 PR 的负担和临床特征。我们检索了 PubMed、Embase、Web of Science、CINAHL、Scopus、Cochrane Library、ProQuest 和 OpenGrey 中有关 HIV 阴性儿童（小于 18 岁） PR 的研究报告。我们纳入了观察性研究，包括至少有五个病例的病例系列。我们提取了有关 PR 的发病率/流行率、临床特征、风险因素、管理策略和结果的数据。我们使用美国国立卫生研究院的质量评估工具和乔安娜-布里格斯研究所的批判性评估工具对纳入研究的偏倚风险进行了评估。我们采用随机效应荟萃分析法对流行率数据进行了汇总。我们确定了 1,673 项研究，其中 10 项符合纳入条件。这些研究描述了 133 名 HIV 阴性儿童的 PR 情况。汇总患病率为 8.8%（95% CI：2.9%，14.6%）。由于各研究之间存在异质性，因此无法确定发生 PR 的风险因素。有限的数据表明，发生 PR 的儿童年龄较小，且多患有神经系统或淋巴结结核。大多数患儿接受皮质类固醇治疗，但数据不足以确定最佳治疗策略。综述显示，每 12 个接受结核病治疗的 HIV 阴性儿童中，就有近 1 个患 PR。研究的缺乏强调了监测/研究的必要性，以更好地描述临床特征、风险因素、适当的管理策略和结果。
{"title":"Paradoxical Reaction to Tuberculosis Therapy among HIV-Negative Children: A Systematic Review and Meta-Analysis.","authors":"Nabaneeta Dash,Lovely Jain,Meenakshi Malik,Pranita Pradhan,Monica Choudhary,Phani Priya Mandula,Kulbir Kaur,Abhishek Purohit,Joseph L Mathew","doi":"10.4269/ajtmh.24-0174","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0174","url":null,"abstract":"Tuberculosis treatment is sometimes associated with clinical deterioration, referred to as paradoxical reaction (PR), especially in those with HIV coinfection. However, the burden and characteristics of PR in children without HIV coinfection are unclear. We undertook a systematic review to estimate the burden and clinical characteristics of PR in HIV-negative children. We searched PubMed, Embase, Web of Science, CINAHL, Scopus, Cochrane Library, ProQuest, and OpenGrey for studies reporting PR in HIV-negative children (<18 years old). We included observational studies including case series with at least five cases. Data on incidence/prevalence, clinical features, risk factors, management strategies, and outcome of PR were extracted. Risk of bias in the included studies was assessed using the NIH's quality assessment and Joanna Briggs Institute critical appraisal tools. We pooled the prevalence data using random effects meta-analysis. We identified 1,673 studies, of which 10 were eligible for inclusion. They described PR in 133 HIV-negative children. The pooled prevalence was 8.8% (95% CI: 2.9%, 14.6%). Owing to heterogeneity among studies, risk factors for the development of PR could not be identified. Limited data suggested that children developing PR were younger and had neurological or lymph node tuberculosis more often. Most children were treated with corticosteroids, but data were insufficient to identify the optimal management strategy. The review showed that PR affects nearly 1 in 12 HIV-negative children receiving tuberculosis treatment. The paucity of studies emphasizes the need for surveillance/studies to better characterize clinical features, risk factors, appropriate management strategies, and outcome.","PeriodicalId":520106,"journal":{"name":"The American Journal of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diagnosis and monitoring of nerve function impairment (NFI) presents an ongoing challenge in global leprosy control. This was a prospective, observational study in leprosy patients receiving treatment with cutaneous and neurological examinations done every 3 months for 1 year. High-resolution ultrasonography and color Doppler (HRUS-CD) was performed in all patients at baseline, completion of treatment, and anytime during the study period if a patient had deterioration of nerve function noted clinically. All peripheral nerves were assessed, and parameters studied were cross-sectional area (CSA), length of thickening, endoneural flow signals (ENFS), and distortion in fascicular symmetry. Of 54 treatment-naive leprosy patients, loss of sensation was noted in 37 (68.5%), paresthesia in 20 (37.0%), and neuropathic pain in 7 (12.9%) at baseline presentation. At end of treatment of leprosy, maximum improvement in NFI across all clinical criteria was seen in ulnar and radial nerves (P <0.05). The number of impairments on HRUS-CD decreased consistently, significantly for ulnar (P = 0.009 right ulnar, P = 0.012 left ulnar) and right radial (P = 0.025) nerves, and significant improvements in CSA and ENFS were seen across multiple nerves, which correlated with improvement in NFI as well. Abnormal HRUS-CD findings in the target nerves were significantly associated with multibacillary cases (odds ratio [OR]: 4.33; 95% CI: 0.62-30.31), those in reaction (OR: 9.42; 95% CI: 1.51-58.66), and those older than 40 years (OR: 3.14; 95% CI: 0.49-19.93). This study provides objective evidence of improvement in NFI with anti-leprosy treatment, supporting integration of HRUS-CD imaging in monitoring nerve involvement in leprosy.
{"title":"Exploring the Utility of High-Resolution Ultrasonography and Color Doppler of Peripheral Nerves in Monitoring Response to Treatment in Leprosy Patients: A Prospective, Observational Study.","authors":"Apoorva Sharma,Tarun Narang,Mahesh Prakash,Bijaya Kumar Padhi,Sunil Dogra","doi":"10.4269/ajtmh.24-0256","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0256","url":null,"abstract":"Diagnosis and monitoring of nerve function impairment (NFI) presents an ongoing challenge in global leprosy control. This was a prospective, observational study in leprosy patients receiving treatment with cutaneous and neurological examinations done every 3 months for 1 year. High-resolution ultrasonography and color Doppler (HRUS-CD) was performed in all patients at baseline, completion of treatment, and anytime during the study period if a patient had deterioration of nerve function noted clinically. All peripheral nerves were assessed, and parameters studied were cross-sectional area (CSA), length of thickening, endoneural flow signals (ENFS), and distortion in fascicular symmetry. Of 54 treatment-naive leprosy patients, loss of sensation was noted in 37 (68.5%), paresthesia in 20 (37.0%), and neuropathic pain in 7 (12.9%) at baseline presentation. At end of treatment of leprosy, maximum improvement in NFI across all clinical criteria was seen in ulnar and radial nerves (P <0.05). The number of impairments on HRUS-CD decreased consistently, significantly for ulnar (P = 0.009 right ulnar, P = 0.012 left ulnar) and right radial (P = 0.025) nerves, and significant improvements in CSA and ENFS were seen across multiple nerves, which correlated with improvement in NFI as well. Abnormal HRUS-CD findings in the target nerves were significantly associated with multibacillary cases (odds ratio [OR]: 4.33; 95% CI: 0.62-30.31), those in reaction (OR: 9.42; 95% CI: 1.51-58.66), and those older than 40 years (OR: 3.14; 95% CI: 0.49-19.93). This study provides objective evidence of improvement in NFI with anti-leprosy treatment, supporting integration of HRUS-CD imaging in monitoring nerve involvement in leprosy.","PeriodicalId":520106,"journal":{"name":"The American Journal of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shu Zhu,Naoko Yoshida,Ryo Matsushita,Mohammad Sofiqur Rahman,Kazuko Kimura
Substandard and falsified medical products for treating COVID-19 have spread worldwide. These medicines have entered Japan through personal importation of products purchased via the Internet. In this study, we investigated the circulation of 19 COVID-19-related medicines on the Internet in Japan and evaluated the pharmaceutical quality and authenticity of 2 medicines (dexamethasone tablets and ivermectin tablets) obtained online. We purchased 23 samples of 0.5-mg dexamethasone tablets and 13 samples of 3-mg ivermectin tablets from the Internet in December 2020 and July 2022. We investigated the quality and authenticity of the obtained samples through visual observation and tested their authenticity. We conducted pharmacopoeia compliance testing (quantitative assay, content uniformity tests, and dissolution tests) using the high-performance liquid chromatography-photodiode array detector method. No prescription was ever required at the time of purchase. Visual observation revealed that most samples lacked a package insert and some samples had packaging deficiencies. In terms of authenticity, eight ivermectin samples were genuine; the authenticity of the other samples remained uncertain. Four dexamethasone samples and three ivermectin samples failed quality testing based on pharmacopeia validation standards. Our findings illustrate that dexamethasone and ivermectin tablets of poor quality are available online. It is important to increase consumer awareness and provide information about these medicines to prevent the purchase of substandard medicines via the Internet.
{"title":"Circulation of COVID-19-Related Medicines on Japanese Websites during the COVID-19 Pandemic and Their Quality and Authenticity.","authors":"Shu Zhu,Naoko Yoshida,Ryo Matsushita,Mohammad Sofiqur Rahman,Kazuko Kimura","doi":"10.4269/ajtmh.23-0710","DOIUrl":"https://doi.org/10.4269/ajtmh.23-0710","url":null,"abstract":"Substandard and falsified medical products for treating COVID-19 have spread worldwide. These medicines have entered Japan through personal importation of products purchased via the Internet. In this study, we investigated the circulation of 19 COVID-19-related medicines on the Internet in Japan and evaluated the pharmaceutical quality and authenticity of 2 medicines (dexamethasone tablets and ivermectin tablets) obtained online. We purchased 23 samples of 0.5-mg dexamethasone tablets and 13 samples of 3-mg ivermectin tablets from the Internet in December 2020 and July 2022. We investigated the quality and authenticity of the obtained samples through visual observation and tested their authenticity. We conducted pharmacopoeia compliance testing (quantitative assay, content uniformity tests, and dissolution tests) using the high-performance liquid chromatography-photodiode array detector method. No prescription was ever required at the time of purchase. Visual observation revealed that most samples lacked a package insert and some samples had packaging deficiencies. In terms of authenticity, eight ivermectin samples were genuine; the authenticity of the other samples remained uncertain. Four dexamethasone samples and three ivermectin samples failed quality testing based on pharmacopeia validation standards. Our findings illustrate that dexamethasone and ivermectin tablets of poor quality are available online. It is important to increase consumer awareness and provide information about these medicines to prevent the purchase of substandard medicines via the Internet.","PeriodicalId":520106,"journal":{"name":"The American Journal of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karen B Jacobson,Katharina Röltgen,Brandon Lam,Patience Nayebare,Abel Kakuru,Jimmy Kizza,Miriam Aguti,Felistas Nankya,Jessica Briggs,Saki Takahashi,Bryan Greenhouse,Isabel Rodriguez-Barraquer,Kattria van der Ploeg,Jacob N Wohlstadter,George B Sigal,Michelle E Roh,Joaniter I Nankabirwa,Gloria Cuu,Stephanie L Gaw,Philip J Rosenthal,Moses R Kamya,Isaac Ssewanyana,Grant Dorsey,Scott D Boyd,Prasanna Jagannathan
Many questions remain about the prevalence and effects of SARS-CoV-2 infection in malaria-endemic African countries like Uganda, particularly in vulnerable groups such as pregnant women. We describe SARS-CoV-2 immunoglobulin (Ig)G and IgM antibody responses and clinical outcomes in mother-infant dyads enrolled in malaria chemoprevention trials in Uganda. From December 2020-February 2022, among 400 unvaccinated pregnant women enrolled at 12-20 weeks gestation and followed through delivery, 128 (32%) were seronegative for anti-SARS-CoV-2 IgG and IgM at enrollment and delivery, 80 (20%) were infected prior to or early in pregnancy, and 192 (48%) were infected or re-infected with SARS-CoV-2 during pregnancy. We observed preferential binding of plasma IgG to Wuhan-Hu-1-like antigens in individuals seroconverting up to early 2021, and to Delta variant antigens in a subset of individuals in mid-2021. Breadth of IgG binding to all variants improved over time, consistent with affinity maturation of the antibody response in the cohort. No women experienced severe respiratory illness during the study. SARS-CoV-2 infection in early pregnancy was associated with lower median length-for-age Z-score at age 3 months compared with no infection or late pregnancy infect (-1.54 versus -0.37 and -0.51, P = 0.009). These findings suggest that pregnant Ugandan women experienced high levels of SARS-CoV-2 infection without severe respiratory illness. Variant-specific serology testing demonstrated evidence of antibody affinity maturation at the population level. Early gestational SARS-CoV-2 infection was associated with transient shorter stature in early infancy. Further research should explore the significance of this finding and define targeted measures to prevent infection in pregnancy.
{"title":"Gestational SARS-CoV-2 Infection in a Ugandan Birth Cohort: High Incidence, Mild Maternal Disease, and Evidence of Association with Transient Infant Stunting.","authors":"Karen B Jacobson,Katharina Röltgen,Brandon Lam,Patience Nayebare,Abel Kakuru,Jimmy Kizza,Miriam Aguti,Felistas Nankya,Jessica Briggs,Saki Takahashi,Bryan Greenhouse,Isabel Rodriguez-Barraquer,Kattria van der Ploeg,Jacob N Wohlstadter,George B Sigal,Michelle E Roh,Joaniter I Nankabirwa,Gloria Cuu,Stephanie L Gaw,Philip J Rosenthal,Moses R Kamya,Isaac Ssewanyana,Grant Dorsey,Scott D Boyd,Prasanna Jagannathan","doi":"10.4269/ajtmh.23-0801","DOIUrl":"https://doi.org/10.4269/ajtmh.23-0801","url":null,"abstract":"Many questions remain about the prevalence and effects of SARS-CoV-2 infection in malaria-endemic African countries like Uganda, particularly in vulnerable groups such as pregnant women. We describe SARS-CoV-2 immunoglobulin (Ig)G and IgM antibody responses and clinical outcomes in mother-infant dyads enrolled in malaria chemoprevention trials in Uganda. From December 2020-February 2022, among 400 unvaccinated pregnant women enrolled at 12-20 weeks gestation and followed through delivery, 128 (32%) were seronegative for anti-SARS-CoV-2 IgG and IgM at enrollment and delivery, 80 (20%) were infected prior to or early in pregnancy, and 192 (48%) were infected or re-infected with SARS-CoV-2 during pregnancy. We observed preferential binding of plasma IgG to Wuhan-Hu-1-like antigens in individuals seroconverting up to early 2021, and to Delta variant antigens in a subset of individuals in mid-2021. Breadth of IgG binding to all variants improved over time, consistent with affinity maturation of the antibody response in the cohort. No women experienced severe respiratory illness during the study. SARS-CoV-2 infection in early pregnancy was associated with lower median length-for-age Z-score at age 3 months compared with no infection or late pregnancy infect (-1.54 versus -0.37 and -0.51, P = 0.009). These findings suggest that pregnant Ugandan women experienced high levels of SARS-CoV-2 infection without severe respiratory illness. Variant-specific serology testing demonstrated evidence of antibody affinity maturation at the population level. Early gestational SARS-CoV-2 infection was associated with transient shorter stature in early infancy. Further research should explore the significance of this finding and define targeted measures to prevent infection in pregnancy.","PeriodicalId":520106,"journal":{"name":"The American Journal of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Toxoplasmosis is a zoonotic disease caused by the obligate intracellular protozoan Toxoplasma gondii. The current study assessed the seroepidemiological status and risk factors of T. gondii in the West Bank, Palestine. We conducted a retrospective study among 1,475 patients referred for serological examination for toxoplasmosis between 2017 and 2021 at the Central Public Health Laboratory. The overall prevalences of anti-T. gondii IgG and IgM antibodies were 1.0% [18.9-23.0%] and 1.0% [0.5-1.6%], respectively. Multifactorial analysis showed that age and sex were significantly associated with the presence of IgG antibodies. The prevalence of IgG antibodies was highest in 2018 and decreased significantly each year until 2021. Routine serological screening in women of childbearing age and pregnant women is recommended.
{"title":"Seroprevalence and Distribution of Toxoplasma gondii Infections among Patients in the West Bank, Palestine (2017-2021).","authors":"Rania Abu Seir,Jerzy M Behnke,Marawan Abu-Madi","doi":"10.4269/ajtmh.23-0721","DOIUrl":"https://doi.org/10.4269/ajtmh.23-0721","url":null,"abstract":"Toxoplasmosis is a zoonotic disease caused by the obligate intracellular protozoan Toxoplasma gondii. The current study assessed the seroepidemiological status and risk factors of T. gondii in the West Bank, Palestine. We conducted a retrospective study among 1,475 patients referred for serological examination for toxoplasmosis between 2017 and 2021 at the Central Public Health Laboratory. The overall prevalences of anti-T. gondii IgG and IgM antibodies were 1.0% [18.9-23.0%] and 1.0% [0.5-1.6%], respectively. Multifactorial analysis showed that age and sex were significantly associated with the presence of IgG antibodies. The prevalence of IgG antibodies was highest in 2018 and decreased significantly each year until 2021. Routine serological screening in women of childbearing age and pregnant women is recommended.","PeriodicalId":520106,"journal":{"name":"The American Journal of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Human monkeypox virus infection (mpox) is a reemerging viral zoonotic disease that has been occurring outside of locations where it has been endemic in Africa. To understand the shifting epidemiology of this disease and respond accordingly, increased clinical skill and professional capabilities are essential. However, there are no studies assessing the knowledge of healthcare professionals in Ethiopia on mpox. Hence, this paper aimed to assess knowledge of the infection and associated factors among healthcare providers in Addis Ababa, Ethiopia, specifically knowledge of diagnosis and treatment of mpox, from November 14, 2022 to November 25, 2022. A facility-based cross-sectional study design was used. Knowledge was assessed using a structured questionnaire, and a 70% Bloom's cutoff point was used to classify the scores. A pretest was conducted in a similar setting before data collection. Frequencies, percentages, and bivariate and multivariate logistic regression analyses were used. The majority of participants, 128 (64.6% with 95% CI), scored below 70% on knowledge questions. Professionals with experience of 5 years or less had better knowledge than those who had worked longer (adjusted odds ratio: 0.301; 95% CI: 0.149-0.609; P = 0.000). Knowledge of mpox among healthcare providers in Addis Ababa was poor across sociodemographic and professional variables. Thus, education on mpox among healthcare providers in Ethiopia is critical in preparing the workforce and limiting potential damage to the country.
{"title":"Knowledge of Human Monkeypox Virus Infection among Healthcare Providers and Associated Factors in Addis Ababa, Ethiopia.","authors":"Sofonias Girma Bekele,Walelegn Worku Yallew,Hanna Melesse","doi":"10.4269/ajtmh.24-0247","DOIUrl":"https://doi.org/10.4269/ajtmh.24-0247","url":null,"abstract":"Human monkeypox virus infection (mpox) is a reemerging viral zoonotic disease that has been occurring outside of locations where it has been endemic in Africa. To understand the shifting epidemiology of this disease and respond accordingly, increased clinical skill and professional capabilities are essential. However, there are no studies assessing the knowledge of healthcare professionals in Ethiopia on mpox. Hence, this paper aimed to assess knowledge of the infection and associated factors among healthcare providers in Addis Ababa, Ethiopia, specifically knowledge of diagnosis and treatment of mpox, from November 14, 2022 to November 25, 2022. A facility-based cross-sectional study design was used. Knowledge was assessed using a structured questionnaire, and a 70% Bloom's cutoff point was used to classify the scores. A pretest was conducted in a similar setting before data collection. Frequencies, percentages, and bivariate and multivariate logistic regression analyses were used. The majority of participants, 128 (64.6% with 95% CI), scored below 70% on knowledge questions. Professionals with experience of 5 years or less had better knowledge than those who had worked longer (adjusted odds ratio: 0.301; 95% CI: 0.149-0.609; P = 0.000). Knowledge of mpox among healthcare providers in Addis Ababa was poor across sociodemographic and professional variables. Thus, education on mpox among healthcare providers in Ethiopia is critical in preparing the workforce and limiting potential damage to the country.","PeriodicalId":520106,"journal":{"name":"The American Journal of Tropical Medicine and Hygiene","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142261929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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